Healthcare Provider Details

I. General information

NPI: 1821330374
Provider Name (Legal Business Name): HANH HONG PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 FAIR LAKES PKWY
FAIRFAX VA
22033-3952
US

IV. Provider business mailing address

9210 TOPAZ ST
FAIRFAX VA
22031-1343
US

V. Phone/Fax

Practice location:
  • Phone: 703-934-5800
  • Fax: 703-934-5835
Mailing address:
  • Phone: 703-912-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202204828
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: